Progression of HIV disease in a haemophilic cohort followed for 11 years and the effect of treatment.

OBJECTIVE--To describe the progression of HIV disease in a haemophilic cohort and to show the influence of treatment. DESIGN--11 year longitudinal clinical and laboratory study. SETTING--A haemophilia centre. PATIENTS--111 patients infected with HIV during October 1979 to July 1985. MAIN OUTCOME MEASURES--Symptoms of HIV infection, AIDs, and death. INTERVENTIONS--26 asymptomatic patients started taking zidovudine or placebo (1000 mg/day) during November 1988 to February 1990; 10 patients with CD4+ counts of 0.2 x 10(9)/l started zidovudine 500 mg/day during January to November 1990. 35 patients used pentamidine for primary or secondary prophylaxis. RESULTS--At 11 years from seroconversion the estimated rate of progression to AIDS was 42% (95% confidence interval 27% to 57%); to symptoms 85% (75% to 95%); and to death 41% (25% to 57%). Progression to AIDS was significantly faster in patients aged 25 and over than in those aged less than 25 (relative risk 5.0 (2.4 to 10.4); p less than 0.00001) and in those with previous cytomegalovirus infection than in those not infected (relative risk 3.0 (1.4 to 6.8); p = 0.006). 16 of 27 (59%) patients with p24 antigenaemia developed AIDS compared with 17 of 84 (20%) patients without p24 antigen (p less than 0.001). The risk of progression to AIDS before 30 November 1988 in patients with CD4+ counts less than or equal to 0.2 x 10(9)/l was higher than after November 1988 (relative risk 1.9 (0.85 to 4.43); p = 0.1). For 1989 and 1990 the observed cumulative numbers of AIDS cases (among 81 patients with sufficient CD4+ counts) were 22 and 25 compared with 29 and 37 predicted from the rate of fall of CD4+ counts up to the end of 1988 (p = 0.03). CONCLUSION--Treatment seems to be reducing the progression of HIV disease in this haemophilic cohort.

[1]  C. Lee,et al.  The treatment of HIV associated thrombocytopenia in haemophiliacs. , 2008, Clinical and laboratory haematology.

[2]  C. Lee,et al.  Zidovudine treatment for anti-HIV positive haemophiliacs. , 2008, Clinical and laboratory haematology.

[3]  Christine A. Lee,et al.  Serial CD4 lymphocyte counts and development of AIDS , 1991, The Lancet.

[4]  J. Weber,et al.  Relation between humoral responses to HIV gag and env proteins at seroconversion and clinical outcome of HIV infection. , 1991, BMJ.

[5]  R. Weber,et al.  Progression of HIV infection in misusers of injected drugs who stop injecting or follow a programme of maintenance treatment with methadone. , 1990, BMJ.

[6]  G. Rutherford,et al.  Course of HIV-I infection in a cohort of homosexual and bisexual men: an 11 year follow up study. , 1990, BMJ.

[7]  J. Darbyshire,et al.  Early HIV infection: to treat or not to treat? , 1990, BMJ.

[8]  N. Benowitz,et al.  Oral therapy for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. A controlled trial of trimethoprim-sulfamethoxazole versus trimethoprim-dapsone. , 1990, The New England journal of medicine.

[9]  G. Friedland.  Early treatment for HIV: the time has come. , 1990, The New England journal of medicine.

[10]  A. Simonds,et al.  Alveolar targeting of aerosol pentamidine. Toward a rational delivery system. , 1990, The American review of respiratory disease.

[11]  Christine A. Lee,et al.  Symptomless HIV infection after more than ten years , 1990, The Lancet.

[12]  Montgomery Ab.  Prophylaxis of Pneumocystis carinii pneumonia in patients infected with the human immunodeficiency virus type 1. , 1989 .

[13]  A. Phillips,et al.  Prediction of progression to AIDS by analysis of CD4 lymphocyte counts in a haemophilic cohort. , 1989, AIDS.

[14]  J. Goedert,et al.  A prospective study of human immunodeficiency virus type 1 infection and the development of AIDS in subjects with hemophilia. , 1989, The New England journal of medicine.

[15]  A. Simonds,et al.  SIMPLE NEBULISER MODIFICATION TO ENHANCE ALVEOLAR DEPOSITION OF PENTAMIDINE , 1989, The Lancet.

[16]  G. Rutherford,et al.  The natural history of transfusion-associated infection with human immunodeficiency virus. Factors influencing the rate of progression to disease. , 1989, The New England journal of medicine.

[17]  P. Griffiths,et al.  The natural history of human immunodeficiency virus infection in a haemophilic cohort , 1989, British journal of haematology.

[18]  P. Griffiths,et al.  CYTOMEGALOVIRUS INFECTION AND PROGRESSION TO AIDS , 1989, The Lancet.

[19]  C. Hay,et al.  CYTOMEGALOVIRUS, SERUM β2 MICROGLOBULIN, AND PROGRESSION TO AIDS IN HIV-SEROPOSITIVE HAEMOPHILIACS , 1989, The Lancet.

[20]  S. Aho,et al.  CYTOMEGALOVIRUS INFECTION AND PROGRESSION TO AIDS , 1989, The Lancet.

[21]  P. Griffiths,et al.  CYTOMEGALOVIRUS INFECTION AND PROGRESSION TOWARDS AIDS IN HAEMOPHILIACS WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION , 1989, The Lancet.

[22]  Christine A. Lee,et al.  Interferon therapy for chronic non‐A non‐B and chronic delta liver disease in haemophilia , 1989, British journal of haematology.

[23]  R. Doll,et al.  Incidence of AIDS and excess of mortality associated with HIV in haemophiliacs in the United Kingdom: report on behalf of the directors of haemophilia centres in the United Kingdom. , 1989, BMJ.

[24]  H. Kessler,et al.  Treatment of human immunodeficiency virus-related thrombocytopenia with zidovudine. , 1988, JAMA.

[25]  J. Giesecke,et al.  Incidence of symptoms and AIDS in 146 Swedish haemophiliacs and blood transfusion recipients infected with human immunodeficiency virus. , 1988, BMJ.

[26]  P. Carey,et al.  SHORT-COURSE ALPHA-INTERFERON THERAPY IN SEVERE UNRESPONSIVE IMMUNE THROMBOCYTOPENIC PURPURA , 1988, The Lancet.

[27]  H. Balfour,et al.  Prevalence of cytomegalovirus antibody in hemophiliacs and homosexuals infected with human immunodeficiency virus type 1 , 1988, Transfusion.

[28]  G. Savidge,et al.  High‐dose intravenous immunoglobulin and splenectomy for the treatment of HIV‐related immune thrombocytopenia in patients with severe haemophilia , 1988, British journal of haematology.

[29]  H. Thomas,et al.  Treatment of thrombocytopenia with alfa interferon. , 1987, British medical journal.

[30]  J. Goudsmit,et al.  Risk of AIDS related complex and AIDS in homosexual men with persistent HIV antigenaemia. , 1987, British medical journal.

[31]  M A Fischl,et al.  The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. A double-blind, placebo-controlled trial. , 1987, The New England journal of medicine.

[32]  J. Goedert,et al.  Natural history of human immunodeficiency virus infections in hemophiliacs: effects of T-cell subsets, platelet counts, and age. , 1987, Annals of internal medicine.

[33]  D. Longo,et al.  Correlation between immunologic function and clinical subpopulations of patients with the acquired immune deficiency syndrome. , 1985, The American journal of medicine.

[34]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[35]  W. Leonard.  An Outlook Report , 1958 .

[36]  W. Blattner,et al.  HIV prevalence estimates and AIDS case projections for the United States: report based upon a workshop. , 1990, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[37]  N. Breslow,et al.  Statistical methods in cancer research. Volume II--The design and analysis of cohort studies. , 1987, IARC scientific publications.